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Thrombectomy is a surgical procedure aimed at removing a thrombus, or blood clot, from specific veins in the body, particularly the vena cava, iliac vein, or femoropopliteal vein. This procedure can be performed directly or with the assistance of a catheter, depending on the location and nature of the thrombus. The procedure typically involves making incisions in the abdomen and/or leg to access the affected vein. A thrombus often forms in areas where the vein is narrowed or stenotic, which can impede blood flow and lead to complications. During the thrombectomy, the surgeon makes an incision in the abdomen and/or leg or groin to expose the vein and access the planned venotomy site. To control blood flow during the procedure, vessel loops are placed both proximal and distal to the thrombus. The vein is then incised, allowing for direct removal of the thrombus through the incision. Alternatively, if a catheter is used, a balloon catheter may be inserted through a venotomy at a site beyond the thrombus. This catheter is passed beyond the clot, inflated, and then withdrawn, effectively capturing and removing the thrombus. After the thrombus is removed, a venography may be performed to confirm that the entire clot has been successfully extracted and that the vein is patent, meaning it is open and unobstructed. It is important to note that specific CPT codes are designated for different approaches to thrombectomy, such as using an abdominal incision alone or a leg incision alone, with CPT® Code 34451 specifically indicating the use of both abdominal and leg incisions for the procedure.
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The thrombectomy procedure is indicated for the removal of thrombus in specific venous locations, particularly when there is a risk of complications due to impaired blood flow. The following conditions may warrant the performance of this procedure:
The thrombectomy procedure involves several critical steps to ensure effective removal of the thrombus. The following procedural steps outline the process:
Following the thrombectomy procedure, patients may require monitoring for any complications related to the surgery. Expected recovery may include managing pain at the incision sites and monitoring for signs of bleeding or infection. Patients may also undergo follow-up imaging studies to confirm the success of the procedure and ensure that the vein remains patent. Additional considerations may include recommendations for lifestyle modifications or anticoagulation therapy to prevent future thrombus formation, although specific post-procedure care instructions should be tailored to the individual patient's needs and the surgeon's protocols.
| Short Descr | REMOVAL OF VEIN CLOT | Medium Descr | THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN ABDL&LEG | Long Descr | Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by abdominal and leg incision | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 60 - Embolectomy and endarterectomy of lower limbs |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | RT | Right side (used to identify procedures performed on the right side of the body) |
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| Pre-1990 | Added | Code added. |
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